International Journal of Endocrinology and Metabolism
Volume:3 Issue: 4, dec 2005

The aim of this study was to identify risk factors for the development of retinopathy and microalbuminuria and their relation in type 2 diabetic patients. In this cross-sectional study, 590 patients suffering from type 2 diabetes were examined. Fundoscopy was performed by an ophthalmologist. The ratio of urinary albumin to creatinine was assessed by clinitek 100 (Bayer corporation–USA). HbA1C, height and weight also were measured. The overall prevalence of retinopathy was 39.3% (232 patients), 5.4% of which proved to be proliferative diabetic retinopathy (PDR). The diabetic retinopathy had a significant inverse relationship with body mass index (BMI) (P=0.02). HbA1C was higher in patients with PDR (mean=10.5%) than in patients with no signs of retinopathy (mean=9.5%), (P=0.001). The prevalence of microalbuminuria was 25.9% while 14.5% of the patients were seen to have macroalbuminuria. As expected, diabetic retinopathy and renal involvement were highly positively related. (P=0.001). Microalbuminuria is associated with diabetic retinopathy in type 2 diabetic patients and is a reliable marker of retinopathy.

Many studies have been performed to compare WHO and ADA criteria for detection of diabetic patients. This study aims to compare these two criteria in a community-based epidemiological survey in an urban population of Tehran, Iran. Subjects were chosen from among 15005 urban individuals, 3 years old and over, selected by cluster random sampling in the cross-sectional phase of a longitudinal study conducted in the east of Tehran; there were 3870 men and 5359 women aged 20 years and over. Those with known diabetes were excluded. Blood samples were taken after 12-14 hours overnight fast and 2 hours post 75gr glucose taken orally. Prevalence of glucose tolerance categories and the level of agreement (ĸ statistic) were obtained using WHO and ADA criteria. Based on WHO criteria 6.0% (0.95 CI, 5.5-6.5) had type-2 diabetes and 13.0% (12.3-13.7) had IGT (Impaired glucose tolerance). Using ADA, 3.3% (2.9-3.7) had type-2 diabetes and 4.8% (4.4-5.2) had IFG (Impaired fasting glucose); p<0.05 and <0.001 for diabetes and IGT, respectively and 7355 (84%) had concordance with both criteria. Among 7105 normal subjects classified according to WHO criteria, 153 (2.2%) had IFG or diabetes by ADA, whereas from 8068 normal subjects according to ADA criteria, 1116 (13.8%) had IGT or diabetes based on WHO criteria. The level of agreement (ĸ statistic) between the two criteria was 35% (p<0.001). Sensitivity and specificity of ADA criteria were 45.5 and 100%, respectively, considering WHO as the gold standard. Our data shows a low level of agreement between WHO and ADA diagnostic criteria for detection of diabetes. Patients with unknown diabetes, glucose disorders are detected more frequently using WHO criteria.

Diabetic foot ulceration is a major source of morbidity and mortality in patients with diabetes mellitus. Diabetics are 40 times more likely to suffer a lowerlimb amputation than those without the condition and as such the importance of this DM complication cannot be over-emphasized. This study sets out to describe and determine the prevalence of the “foot at risk” for ulceration in diabetic patients in an urban out patient clinic in Lagos, Nigeria. Subjects and This was a cross-sectional study carried out at the Diabetes Clinic of the Lagos University Teaching Hospital, Lagos, Nigeria for a period of one year (2001-2002). One thousand, one hundred and forty patients with diabetes mellitus (DM) were screened to obtain a number of 474 with the foot at risk for ulceration. The “foot at risk” in people with diabetes mellitus (DM) refers to the foot with intact skin which may have bony deformities or preulcerative lesions such as claw toes, hammer toes, hallux valgus, prominent metatarsal heads, callus formation, bunion, bunionnette, charcot/ bony prominences, dry skin, warm foot with prominent vessels, previous ulceration and or amputation, onychomycosis, features of neuropathy and vasculopathy. Data was analyzed using the Statistical package for the social sciences (SPSS) version 10. The prevalence of DM patients with the foot at risk in this study (41.5%) was high. Of the 474 study subjects with the “foot at risk” for ulceration, 9(1.9%) had type 1 DM and 465 (98.1%) had type 2 DM. More than half of the patients were elderly (>61years) and either overweight or obese. The duration of diabetes and the mean fasting plasma glucose was higher in patients with type 1 DM but this difference was not statistically significant. In both types of diabetes, more than 50% of the subjects had poor glucose control. The 41.5% prevalence of the footat- risk for ulceration among Nigerian patients with diabetes mellitus is high. In a resource poor country like Nigeria, in order to prevent foot ulceration, preventive measures should be targeted mainly at the high risk group.

The major consequence of radioiodine therapy for thyrotoxicosis is hypothyroidism and long-term precise management of hypothyroidism may be problematic. In this study, the long-term outcomes were compared in radioiodine treated euthyroid and hypothyroid patients on thyroid hormone treatment. One hundred and thirty eight patients with diffuse toxic goiter were treated with radioactive iodine. One hundred and seven patients (78%) returned for follow up visits for up to 11.5±0.8 years. Numbers of occurrences of thyroid dysfunction in each patient were recorded and a total cost of management was calculated. At the end, 41 patients (38%) were still euthyroid (group 1) and 66 (62%) became hypothyroid (group 2). Serum, FT4, FT3, TSH, thyroid antibodies, lipid profile, calcium, phosphorus, and PTH were measured and bone mineral density, ECG and echocardiography were performed. There was no significant difference in age, sex, duration of symptoms and thyroid function between the 2 groups. The cost of treatment was lower in group 1 than in group 2. During 11.5 years of follow up, percentage of elevated and suppressed TSH in groups 1 and 2 were 0.02 and 20.5, p<0.001 and 7.9 and 13.4, p<0.001, respectively. At the end of 10 years, goiter rate, serum T4, T3, thyroid antibodies, lipids, Ca, P and PTH and bone mineral density and echocardiography data were not signifanctly different between two groups. However, mean serum TSH and number of TSH above 5 mU/L was greater in roup 2 than 1 (p<0.01). It is concluded that thyroid derangements frequently occur in patients who become hypothyroid after radioiodine therapy, while on replacement therapy.

Hypolipidemic agent fenofibrate has recently been demonstrated to improve carbohydrate metabolism in animal and cell models. The purpose of this study was to determine its clinical effects on glycemic control and the relationship with its hypolipidemic action in type 2 diabetic patients with hyperlipidemia. Forty-eight type 2 diabetic patients with hyperlipidemia were recruited from the Endocrine Division’s outpatient clinic of a tertiary-care university-affiliated centre and randomly assigned micronised fenofibrate 200mg daily or placebo in a doubleblinded, placebo-controlled study for three months. A total of 44 patients completed the study. Main outcome measured were changes from the baseline in fasting and postprandial lipid and glycemic variables. Treatment with micronised fenofibrate resulted in a significant decrease in fasting (3.81 ± 1.86 to 1.90 ± 0.77 mmol/L, p< 0.0001) and postprandial triglyceride (5.36±2.640 to 2.30±1.33 mmol/L, p< 0.0001), total cholesterol (6.18±1.17 to 5.23±0.97 mmol/L, p<0.0001) and non-HDL cholesterol (5.09±1.12 to 3.96±1.11 mmol/L, p<0.0001). After treatment the placebo group showed no significant changes in serum lipid levels. Both groups did not alter in fasting and postprandial plasma glucose, mean HbA1c, fasting insulin, QUICKI index and proinsulin-to-insulin ratio. Micronised fenofibrate significantly improved both fasting and postprandial lipid profiles, but did not affect glycemic variables, insulin resistance, and β cell function in patients with type 2 diabetes.

Short stature is a common feature in Turner’s syndrome; (TS) final height in untreated patients is on average 20cm below the population mean for adult women. When recombinant growth hormone (GH) became available, supraphysiologic GH doses with or without oxandrolone (OX) were administrated in order to improve growth in patients wih TS in several studies The objective of this study was to find out whether moderate doses of growth hormone in combination with oxandrolone and late initiation of puberty could improve adult height even in TS patients with late diagnosis. In this study the data an 68 patients with TS will be reported. Thirtythree patients with chronological age 17 years or above did not receive treatment. Thirty- five patients with TS were randomly assigned to receive either GH alone (0.375 mg/kg/week) by daily S.C injections (Group GH, n = 23) or in combination with OX 6 mg/kg/day P.O (group GH + OX, n = 12). Mean age at the onset of treatment was 10.7 years (GH) and 10.3 years (GH+OX), mean projected adult height (PAH) was 142.1 cm (GH) and 141.5 cm (GH+ ox). Puberty was induced at a mean age of 14.5 years. There was a marked difference in group GH ± OX cumulative growth during 4.3 years of therapy in comparison with untreated TS patients. Twenty-six patients are now near or at final height: Group GH (n=17), mean final height was 148.7 cm (PAH 142.1 cm, gain 6.6 cm); group GH+ OX (n = 9), 151.9 cm (PAH, 141.5 cm, gain 9.4 cm). In the untreated group (n = 33), mean final height was 139.1 cm. Cumulative growth was more significant in GH plus OX than GH alone treated subjects (P<0.001). The diagnosis of TS is often delayed in our country and this defers the timely and appropriate treatment of short stature. Our results are in keeping with studies demonstrating moderate doses of GH plus OX and late induction of puberty are able to improve final height even in patients with TS, treated relatively late.

One of the established risk factors of testicular tumor is undescending testis affected by environmental and genetic factors. We report a case of testicular tumor associated with a history of contralateral undescended testis in a patient of Taleghani hospital in the year 2003. A 38-year-old man visited the hospital complaining of painless swelling of the left scrotal contents. Right orchiectomy had been performed folowing the diagnosis of undescending testis, eight years earlier. He had a firm mass with 10cm
6 cm in the left scrotum and lab tests revealed high alpha-fetoprotein. Left radical inguinal orchiectomy was performed and the pathological diagnosis of the tumor was germ cell tumor, Teratocarcinoma. Previous pathologic report of undescending testis was atrophic testis. In conclusion, considering the higher risk of development of testicular cancer in both gonads in patients with undescending testis, long term follow up is recommended.